| NPI | 1063405462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501010295) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2022-10-25 |